Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Abstract

BackgroundThe aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs).Patients and methodsA total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded.ResultsDuring a median follow-up time of 60 months (18–66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal.ConclusionProphylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.

Optimal Extent of Prophylactic Irradiation of Para-aortic Lymph Nodes in Patients With Uterine Cervical Cancer

“…The five-year OS rate in the EFRT arms was 67% and 52% in RTOG trial 79-20 and RTOG trial 90-01, respectively [21,23]. Recent institutional series showed 5 year OS rates of 73.5% and 72.4%, respectively [24,25]. The 5 year survival rate in our study was superior to those in the previous studies, suggesting that SEFRT excluding the upper PALN does not significantly compromise PALN control, survival outcomes, and toxicities compared with EFRT.…”

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

“…Seventy-four patients were analyzed. In the pelvic concurrent chemoradiotherapy and extended-field concurrent chemoradiotherapy arms, the PALN control rates were 82.1 and 97.1% ( p = 0.02), respectively, the distant control rates were 74.7 and 86.9% ( p = 0.03), respectively, the DFS rates were 69.1 and 80.3% ( p = 0.03), respectively, and the OS rates were 60.4 and 72.4% ( p = 0.04), respectively ( 32 ). This is the only published RCT ( 25 ).…”

“…In the era of concurrent chemoradiotherapy, clinical trials comparing prophylactic EFI and pelvic radiotherapy have been limited. In the study by Asiri et al ( 32 ), 102 patients with FIGO stage IIB-IVA cervical cancer and no evidence of PALN metastasis were randomly assigned to the pelvis concurrent chemoradiotherapy arm (50 patients) and extended-field concurrent chemoradiotherapy arm (52 patients). Seventy-four patients were analyzed.…”

“…In the prophylactic EFI group, the incidences of grade 3–4 acute upper gastrointestinal, lower gastrointestinal, late gastrointestinal and genitourinary toxicities were 0, 5.3, 3.5, and 1.8%, respectively ( 40 ). In the RCT of Asiri et al ( 32 ), radiotherapy was performed with conformal radiation therapy or IMRT. The acute and late toxicities were similar between the pelvic radiotherapy and prophylactic EFI groups.…”

“…The eligibility criteria differ between studies on prophylactic EFI, and the criteria include cervical cancer ( 33 , 35 ), LACC ( 37 , 40 ), FIGO stage IB-IVA ( 34 ), FIGO stage IIB-IVA ( 32 ), and pelvic LN involvement ( 36 , 40 , 47 ), among others. This is an important reason why these studies have contradictory results.…”